The Polish TRES-DEP study assesses a number of demographic, clinical and psychometric features comparing patients with treatment-resistant and treatment non-resistant depression. The study included 1083 patients with single or recurrent depressive episode among which 570 met the criteria for treatment-resistant depression, on account of lack of significant improvement following at least two adequate courses of antidepressant treatment. All 1083 patients were assessed by means of the Polish version of Hypomania Check List 32 Scale. The Cronbach's alpha for entire scale was 0.94 which indicates high degree of consistency. Exploratory factor analysis resulted in five factors, of which the biggest (mostly overactivity and elation) containing items1-6, 7-19, 21, 23 and 27 had eigenvalue 10.95 and accounted for 34.2% and the second (irritability), items 25-26, with eigenvalue 2.92, accounted for 9.1% of total variation. Significant differences were obtained between patients with treatment-resistant and treatment non-resistant depression as to the scores of HCL-32. The mean score of HCL-32 was significantly higher in treatment-resistant vs non-resistant depression (11.9±8.3 vs 8.8±7.7, respectively, p< 0.001). Also, the percentage of patients having positive response to 14 or more items of the scale was significantly higher in treatment-resistant than in non-resistant depression (44% vs 29%, respectively, p< 0.001). Based on the results of HCL-32 scale, it may be concluded that the features of bipolarity make the patient more resistant to antidepressant treatment.

In 1970 antipsychotics (haloperidol, levomepromazine, thiothixene) were recommended in Sweden as 1st line treatment of anxiety in organic brain syndromes, psychoasthenia, and substance abuse. The benzodiazepines came to dominate treatment of anxious patients in the 1970s and are still appreciated for their rapid anxiolytic effect, low clinical toxicity and low price. Evidence-based guidelines, however, recommend the SSRIs, venlafaxine, and pregabalin as first line treatment in anxiety disorders.

Studies are currently ongoing to assess the utility of new antipsychotics in primary anxiety disorders: quetiapine, risperidone, aripiprazole, ziprazidone, and olanzapine. This is justified in the light of that a large proportion of these patients, about 1/3, do not respond to 1st line treatments or discontinue due to adverse drug effects. Augmentation therapy with antipsychotics may enhance response rates. Primary anxiety disorders may include psychotic symptoms such as dissociation, or severe insomnia, that may be targeted with these medications.

Another important patient category are patients with substance use disorders, particularly alcohol, in whom there are few or no controlled studies of conventional anxiolytics. Anxiety is also common among patients with psychoses, bipolar disorder, ADHD or borderline personality disorder, and few controlled studies have addressed that issue.

Emerging reports indicate that new antipsychotics may be useful as 1st line therapy, as augmenters, and in patients with anxiety due to psychoses and bipolar disorder. In this educational update, the results regarding symptoms, adverse effects, and functioning of these recent studies will be discussed.

There are actually four types of situations where intervention with antipsychotics might be considered for the treatment of Obsessive compulsive disorder. Obsessive compulsive patients with poor insight (what was previously called ‘psychotic obsession’), schizophrenic patients with OCD, obsessive compulsive patients with tic disorder, and obsessive compulsive patients who did not respond to intervention with an adequate treatment of antiobsessive medication.

The data supporting the role of antipsychotic medication in obsessive compulsives with poor insight are not convincing. However, at times the treatment dilemma (antipsychotic or antiobsessive) actually derives from diagnostic ambiguity; many of the very severe ego-syntonic obsessive compulsive patients may be erroneously diagnosed as schizophrenic, while they are actually severe OCD that should be treated with antiobsessive medication and not antipsychotic.

The prevalence of OCD amongst schizophrenic patients ranges from 10-25% and has a negative effect on the prognosis for those substantial proportion of schizophrenic patients. Preliminary data implies that for this subset of patient (the schizo-obsessive patients) a combination of antipsychotic and antiobsessive medication might be useful.

It is crucial to screen for tic disorder in patients with, OCD as this subset of patients responds (both in terms of obsession and tics) to a combination of typical antipsychotic and antiobsessive medication.

Data in regard to augmentation of OCD patients who did not respond to treatment with SSRI suggest that risperidone might have a specific therapeutic potential in this subset of patients. The role of antipsychotics with 5HT1D properties like ziprasidone need to be studied.

Temperament and mood swings are promising indicator for the characterization of mood-spectrum vulnerability. The aim of this study was to investigate the relationship between affective temperament and mood swings in bipolar disorder. We explored these clinical features retrospectively. Patients who met the criteria for Bipolar I disorder were enrolled in the study. Exclusion criteria were partial remittance and a full affective or psychotic episode. Data concerning illness and family history, mood swings (semi-structured interview) and depression (BDI) were obtained. We examined premorbid temperament with TEMPS-A, and with the validated German version TEMPS-M. Patients with and without mood swings were compared with respect to the dominant temperament. Out of 20 bipolar patients, 6 subjects reported mood swings prior to the onset of affective disorder. Subjects with mood swings significantly correlated with a positive family history of affective disorders. Concerning cyclothymic, irritable, and hyperthymic temperament, bipolar affective patients with mood swings had higher scores. No differences were found between males and females. Our findings support the assumption that mood swings, as represented by the cyclothymic temperament, could be prodromes of bipolar disorder. These traits may represent vulnerability markers and could presumably be used to identify individuals at high risk for developing bipolar disorder in order to prevent this illness or to modify its course. A further retrospective study with a larger sample size was started to deepen knowledge about putative prodromal symptoms of bipolar disorder.

A capital issue in human psychology is how individuals understand the actions and emotions of others. But the field of social cognition includes different concepts: the mirror system (that allows us to understand other people’s motor actions and action intentions), “theory of mind” (that allows us to understand more abstract concepts such as beliefs or wishes in others) and empathy (that allows us to understand and share emotions and sensations with others). It is known the difficulties of people with schizophrenia in interpreting social information or the “theory of mind” severe deficit in autist children, but nowdays social cognition can be a new point of view in understanding different psychopathologies, such as social phobia, pure delusional disorder or personality disorders. In regard to schizophrenia, the association between ToM deficit and negative symptoms and disorganization has been shown, whereas the association with paranoid symptomatology seems to be more controversial. A supplementary line for debate has been whether a ToM deficit is a state marker or a trait marker in relation to psychosis. In this workshop we will review the importance of this approach and the main -verbal and non-verbal- instruments used to asses social cognition in clinical practice.

Theory of Mind (ToM) is defined as the cognitive ability to infer mental states to oneself and to others, in terms of thought, emotion and intention. There are many studies about ToM in schizophrenia, but a paucity of them about ToM in bipolar disorder, despite the suggesting relationship between ToM and emotions. Some affective patients were included as control group in schizophrenia studies, but these samples were small and heterogeneous. Some authors have found ToM deficit in manic and depressed patients, but there is also some evidence of a ToM deficit even in a state of euthymia, associated to other cognitive deficits, mainly in executive function. Multiple factors could be involved in this ToM deficit, but these studies open the way for a line of research about the cognitive mechanisms underlying the psychosocial disadjustment that these patients present. Mentalization skills could be more decisive for keeping a job or a social network than other neurocognitive variables, and BD remains a very important cause of psychosocial disadvantage. In this workshop we will debate the relevance of these findings in BD and the potential therapeutic consecuences.

Deficits in social cognition have been reported in euthymic bipolar patients. Thus, these deficits could be determining the disability observed in these patients for achieving the functionality expected at work or in sociability. In this way, there is a need for specific programs of rehabilitation in social cognition in bipolar disorder. Unfortunately, there is a paucity of programmes designed for improving social cognition in bipolar patients. A review of these programmes will be presented.

Psychiatry as a medical discipline plays an important role in mental health care (MHC). Hand in hand with increasing demand for MHC transformation toward more individualized, personalized, and patient oriented service, the integrity of psychiatry, the role of psychiatric staff, the stigma, and identity of psychiatry become important questions to be tackled. These questions are related to the leadership role of coming generation of psychiatrists. Is it a challenge or just a myth? We should not deny the fact that in important documents of global importance (e.g., Green paper and other WHO/EU MH documents) there is almost zero occurrence of the word “psychiatry”. So it seems psychiatry is rather marginalized than promoted to be the leading force in MHC policy. EPA YPP program could become a suitable platform to prevent such an undesired process and to formulate ways how to increase motivation, skills and chances of psychiatrists to take control of their own destiny.

In the last decade I served as president of the Dutch Association of Psychiatric Trainees, Secretary General of the European Federation of Psychiatric Trainees and first president ever of the World Association of Young Psychiatrists and Trainees. My ideas were bases on my experience as one of the European leaders of the European Federation of Psychiatric Trainees (EFPT). Psyched and trilled as I was having opportunities faced in the EFPT I thought it would be great to start an world wide association for psychiatric trainees and young psychiatrists. In this presentations I will share my experience as an (new) international leader in Psychiatry and the lessons I learned, the strength, challenges and difference of the World Association of Young Psychiatrists and Trainees (WAYPT) in comparison with the European and Dutch experience.

Learning objectives:

1. 1. the attendee will learn about the competencies an international leader in Psychiatry needs;

2. 2. the attendee will learn about the challenges a international leader faces;

3. 3. the attendee will learn to overview different levels of the organization: national, continental and worldwide.

There is a lack of a precise and biologically verifiable definition of illness, which in turn contributes to the inconsistencies published in the literature on the topic of neurobiological abnormalities within psychiatric diseases. Among the available neuroimaging tools, positron emission tomography (PET) and functional magnetic resonance tomography (fMRI) are the most promising tools. For affective disorders, volumetric and functional dysregulations have been shown in the prefrontal cortex, basal ganglia, amgydala and hippocampus and receptor imaging revealed differences to healthy controls for the serotonin transporter as well as the 5HT1A and 5HT2 receptor. For schizophrenia the volumetric and functional dysregulations have also be obtained in the prefrontal cortex, however, different to affective disorders, in ventricular volume, striatal volume, activity in temporal lobe and changes in receptor imaging with dopamine release as well as dopamine 1 and 2 receptors. Anxiety disorders have been related to volumetric and functional dysregulation in amgydala, prefrontal cortex and hippocampus and the receptor imaging was related to changes in serotonin 5HT1A receptor as well as dopamine 1 receptors. Given the high comorbidity between depression and the different anxiety disorders, it seems to be unlikely that these disorders result in a different biological characteristic. Future research will focus on subgroup analysis encompassing both neuroimaging techniques and molecular changes leading to specific subgroups, which hopefully lead to specific treatment modalities. Specific biomarkers are likely to be characteristic for illness subtypes associated with specific treatment outcomes.

The use of atypical antipsychotics in the treatment of mania has become standard practice as supported by most currently available treatment guidelines. Aripiprazole, asenapine, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone have shown efficacy in placebo-controlled studies in acute mania. Not all these compounds, though, have been tested in maintenance therapy. Aripiprazole, for example, has been evaluated in numerous clinical trials in patients with bipolar disorder. Its efficacy was first established in two 3-week, placebo-controlled trials, and data are now available from a double-blind study of 100 weeks’ duration in manic patients, demonstrating both the effective stabilisation offered by aripiprazole and its superiority over placebo in preventing bipolar recurrence, primarily in preventing recurrence into mania.

Furthermore, the addition of aripiprazole to lithium or valproate in patients who are partially non-responsive to these latter agents, can lead to significant improvement in mania symptoms. Several other atypical antipsychotics have also demonstrated adjunctive efficacy in patients with bipolar disorder, including olanzapine, quetiapine and risperidone. Studies comparing different atypical agents have generally shown that efficacy is similar, although the side effect and tolerability profiles differ between agents.

In conclusion, atypical antipsychotics such as aripiprazole have proven short-and long-term efficacy as monotherapy or adjunctive treatment for bipolar mania, providing physicians with additional options when selecting the best treatment for their patients.

Antipsychotic medication provides effective treatment for patients with schizophrenia and bipolar disorder. Patient satisfaction with antipsychotics is positively associated with improvement in psychotic symptoms and treatment adherence. However, some patients, whilst recognising their need for effective intervention, have specific concerns over their management. If these concerns are not adequately addressed the patients remain unsatisfied and may become non-adherent.

Health-related attitudes and beliefs of the patients and insights about their illness may affect patients’ decisions on taking medications in the short and long term. Therefore, it is essential for physicians to communicate with their patients about their beliefs regarding their mental and physical health. Careful assessment of the environmental characteristics of the patient relevant to health may also decrease the risk of non-adherence. Improvement of a patient's treatment adherence using specific motivational interview techniques should also be discussed.

At the outset patients are often concerned over the possibility of treatment-related adverse events (AEs) such as headache, somnolence and weight gain with antipsychotic treatment. If such AEs do occur, patients have to develop coping strategies and may be tempted to self-manage, which can lead to treatment discontinuation and/or selective adherence.

A joint decision-making process between patient and clinician will allow a rational approach to treatment selection and adherence, and the provision of supportive networks will ensure that there is an opportunity for patients to learn about the effects of their medication.

In the first half of the last century researchers believed that severe mental disorders like schizophrenia have a neuropathological basis. Up to now it has been difficult to prove any consistent core finding for this disorder. Reason for this might be that it is a network disorder and therefore regional specific findings will unlikely be found. Parallel to that describing the dopamine hypothesis of schizophrenia and the catechol amine deficit hypothesis of depression were very helpful for understanding the mechanisms of antipsychotics and antidepressants working in these disorders. Especially the introduction of the positron emission tomography has helped to link symptoms with the transmitter systems. However, none of these findings are specific for schizophrenia or depression. During the talk it will be discussed when the combination of core clinical symptoms, imaging findings and genetic variables are helpful for a future classification of psychiatric disorders.

Case-control differences at the voxel or regional level in structural brain imaging assessments tend to be subtle and non-specific, but these could still be sensitive diagnostic assays in certain situations e.g. in a population at genetic or other risk for a particular disorder. More sophisticated pattern classification methods, such as support vector machines, which use more of the available information, have been applied to distinguish established cases from controls, and to distinguish people at high symptomatic risk of developing schizophrenia who do and do not make the transition. Functional brain imaging techniques are likely to be generally more sensitive and examples of our work will demonstrate this for both high risk and established schizophrenia versus bipolar contrasts.

Cultural background has a significant influence upon how we perceive illness, our attitudes to illness and our help-seeking behaviour.

But culture is only one of many influences on our health related beliefs and behaviours. Other factors include e.g. individual factors related to age, gender, sociodemographic background, but also environmental factors such as urban or rural setting, pollution, globalization.

If we want to understand and assess the impact of culture in a particular clinical case, the use of art may be a valuable tool to facilitate this understanding and serve as a bridge over cultural incongruities.

The paper will discuss ways in which the application of artistic elements in the therapeutic process may serve as a useful intervention and ultimately as a vehicle to increase the cultural competence of mental health staff. In an increasingly complex, globalised world with patient populations originating from all parts of the world this may prove to be a profitable instrument.

Psychopathology of bounding is a central feature in Border Line Adolescents. This feature is underlying both their violent acting and their reluctance to engage in a therapeutic relation. In a milieu treatment, cultural mediations appear as one of the best way to overcome this difficulty because they put the focus on pleasurable activities rather than on the relation itself. It allows the therapeutic staff to find a way out of the paradox where relation which is the main therapeutic solution is at the same time the main psychopathological problem.

This paper will explore possible ways of integrating humanities disciplines in medical education.

In today's world, medical students have to learn to understand the social and cultural environment in which medicine is practiced. The humanities have long since have been the principal site of diversity in the academy. Now they can help medical students come to terms with diversity that is the context ot today's medicine.

Studies in arts and humanities help recognize the limitations of purely biotechnical approach to patient care, in complex and paradigm-changing ways. Such studies also pave the way for understanding how social assumptions and values play out in healthcare policies. In sum, the humanities provide an additional insight into the human condition, allowing students “to consider human beings in their totality,” in the words of Jean Delay, a pioneer of psychopharmacology who also maintained a literary career throughout his life.

Furthermore, humanities contribute to the development of complex interpretive skills, embracing affective aspects of intelligence as much as they embrace conventional rationalist forms of inquiry such as logic, analysis, deconstruction and critique. There is some evidence that medical students who have an additional background in the humanities are less vulnerable to burnout while studying and go on to perform better in important areas of practice. Approaches to developing specific learning outcomes and curricular guidelines will be discussed.

Both disorders are worldwide, lifelong, and recurrent illnesses with periods of exacerbation and partial or full remissions. Lifetime prevalence of schizophrenia and bipolar disorder type I is around 1%. Women and men are affected at proximately equal rates and the typical age of onset is similar. Both disorders also share risk factors showing evidence for impaired prenatal development, such as birth seasonality, abnormal dermatoglyphs and higher incidence of perinatal complications. However, there is evidence for differences in prevalence in geographical isolates, in presence of minor physical abnormalities and possibly also in influence of psychosocial factors, urbanicity and use of cannabis. However, based only on similar epidemiological parameters, it is not possible to assume any degree of continuity between bipolar disorder and schizophrenia. The main evidence for partially shared pathophysiology is given by genetic studies.